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Assessing maternal and neonatal near‐miss reviews in rural Nepal: an implementation research study to inform scale‐up
Author(s) -
Rana Hari Bahadur,
Banjara Megha Raj,
Joshi Mahesh Prasad,
Kurth Ann E.,
Castillo Theresa P.
Publication year - 2018
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14300
Subject(s) - medicine , attrition , government (linguistics) , scale (ratio) , maternal health , intervention (counseling) , near miss , neonatal death , nursing , rural health , neonatal mortality , rural area , family medicine , pediatrics , environmental health , infant mortality , pregnancy , health services , population , philosophy , dentistry , linguistics , forensic engineering , engineering , biology , genetics , fetus , quantum mechanics , physics , pathology
Aim To understand how maternal and neonatal near‐miss reviews could be implemented and scaled‐up in rural communities through the existing district health system in Nepal. Methods Mixed methods with a modified time series evaluation design were used. The World Health Organization maternal and neonatal near‐miss criteria used in multicountry surveys were adapted and used to define maternal and neonatal near‐miss cases. Results The World Health Organization near‐miss criteria were mainly applicable at the district hospital setting, but further adaptations were needed for community‐level birthing centres, as organ dysfunction and critical intervention criteria were not found appropriate. In birthing centres, disease‐based criteria were applicable for maternal near‐miss review, and danger and clinical sign‐based and condition at birth criteria were applicable for neonatal near‐miss review. Primary barriers to implementation were attrition of trained staff due to the frequent transfer of healthcare providers, and time constraints of district hospital medical doctors for case‐by‐case reviews as they were often busy in hospital and in their private clinics. Conclusion Adapted maternal and neonatal near‐miss review process implementation in Nepal is feasible through the existing government health system.